Abstract Introduction Psoriasis affects up to 7.5 million adults in the United States, with approximately one-third developing psoriatic arthritis (PsA). Both conditions share immunopathologic mechanisms, particularly activation of the IL-23/IL-17 axis, affecting multiple organs, including the lungs, where they may contribute to the development of interstitial lung disease (ILD). While ILD is well-described in other autoimmune disorders, its clinical, radiographic, and functional features in psoriasis and PsA remain unclear. This study aimed to characterize ILD in these patients, focusing on comorbidities, imaging patterns, pulmonary function, and DMARD use. Methods We identified patients with ILD and a diagnosis of psoriasis or PsA at University Health, Kansas City, from January 1, 2000, to May 1, 2025. Comprehensive clinical and outcome data were extracted from health records by retrospective chart review. Results 11 patients (mean age 56 years, 8 female, 3 male), 8 with psoriasis and 5 with PsA, met the inclusion criteria. 91% (10/11) of patients had a current (5) or prior (5) smoking history with an average of 27.4 pack-years. Common comorbidities included obstructive sleep apnea (7/11) and chronic obstructive pulmonary disease (6/11). Autoimmune serologies (ANA panel, rheumatoid factor, anti-CCP antibody) were negative, and inflammatory markers were only modestly elevated. CT imaging revealed upper lobe involvement in 54.5% (6/11), with ground-glass opacities and reticulations in 5 and honeycombing in 1. Nonspecific interstitial pneumonia was seen in 27% (3/11), and organizing pneumonia in 9% (1/11); no cases exhibited a usual interstitial pneumonia (UIP) pattern. Pulmonary function testing demonstrated mild restrictive physiology with impaired diffusion capacity (mean FVC 79% predicted, mean DLCO 59% predicted). Methotrexate (5/11) and TNF inhibitors (6/11) were the most frequently used therapies. Targeted synthetic DMARDs and JAK inhibitors (3/11) were less commonly used. Immunosuppressive therapy included azathioprine (2) and low-dose prednisone (3); no antifibrotic agents were administered. 27% (3/11) of patients developed chronic hypoxemic respiratory failure, 36% (4/11) required hospitalization for acute respiratory failure, and overall mortality was 18% (2/11). Conclusion In this single-center cohort, ILD in psoriatic disease predominantly affected the upper lobes with ground-glass and fibrotic changes. Most patients showed mild restrictive physiology with stable pulmonary function over 5 years. Methotrexate and TNF inhibitors were commonly used, but no cases demonstrated acute drug-induced pneumonitis, and ILD often persisted despite therapy. The high prevalence of smoking, OSA, and COPD may contribute to disease development. These findings emphasize the need for further studies to clarify causality and guide treatment. This abstract is funded by: None
Hansraj et al. (Fri,) studied this question.